Care, well-being, and quality of life of people living with HIV and AIDS
Policy, Program, Intervention or other types of research evaluation
Issues : Unfortunately, despite our breakthrough progress, the hepatitis C epidemic persists. In fact, even though hepatitis C medications are easier to take and more affordable than ever, HCV is on the rise, often co-occurring with HIV infection. In New York State, an estimated 280,000 New Yorkers are infected with HCV, and a shocking 50% are unaware of their status. An alarming 14,745 new HCV cases were reported in New York State in 2016, and 6,465 New York City residents were newly reported with confirmed or probable HCV in
2016—a 17% increase from 2015.
Housing Works Community Healthcare launched the Hepatitis C (HCV) Treatment Incentive Program (TIP) in April 2016 as an innovative strategy that employs financial incentives as one tool to engage and retain in curative treatment primary care patients with HCV infection who face multiple barriers to care.
Description : The Hep C TIP integrated approach involves patients, clinicians and case managers in interdisciplinary care planning, and employs a toolkit that includes motivational interviewing, behavioral health interventions, adherence support groups, DOT, and up to five $100 gift card incentives over a one year period for achieving and maintaining undetectable HCV RNA viral loads. Agency-wide training and a social marketing campaign educates clients and staff to engage the full community to improve the HCV treatment cascade in order to “tip” the scale towards HCV elimination.
Lessons learned : As of March 2018, 95% of primary care patients had a current HCV screening, up from 70% in 2016, and 7.2% had been diagnosed with HCV infection, three times the estimated NYC prevalence (2.4%). TIP has enrolled 311 patients, who are 71% male, 67% black or Hispanic, 64% 50yrs or older, and 32% co-infected with HIV. Approximately 20% of TIP patients are currently homeless and 50% have a substance use disorder. Of 311 TIP enrollees, 63% have an undetectable HCV viral load following treatment, 14% are in treatment, 19% are awaiting preauthorization or otherwise prepping for treatment, 3% failed treatment adherence, and <1% has paused treatment.
Recommendations : These results point to the potential of the TIP toolbox, including financial incentives, to support curative HCV care for underserved and hard to reach populations.